M. Fleury1, H. Hakmi1, J. Vosswinkel1, J. Mccormack1, E. Huang1, R. Jawa1 1Stony Brook University Medical Center,Trauma/Surgical Critical Care,Stony Brook, NY, USA
Introduction: A hsitory of alcohol use is often reported in injured patients. We evaluated the association of elevated BAL with outcomes.
Methods: Retrospective analysis of a single ACS verified level 1 trauma center’s registry. Trauma patients >16yrs old, discharged between 1/1/16 and 12/31/17 were included. Emergency room deaths, isolated hip fracture patients, and injuries in nursing homes were excluded. Patients with BAL values were separated into three groups consisting of negative BAL (NBAL <10mg/dl), low positive BAL (LBAL 11-79mg/dl), and high positive BAL (HBAL ≥80mg/dl).
Results: 1797 patients met the study criteria: 17.3% HBAL, 4.6% LBAL, and 78% NBAL. Median [IQR] BAL level was 200.5 [142-265] mg/dL in HBAL and 40 [27-58] in LBAL. The most common mechanisms of injury were: MVC/MCC in the hBAL group (35.3%), MVC/MCC in LBAL (44.6%), and falls in the nBAL group (47.4%). The HBAL group more often had pedestrians struck (12.8% vs 7.2% LBAL, 8.2% NBAL, p=0.03). The elevated BAL groups more often sustained penetrating trauma (7.0% HBAL, 6.0% LBAL, 3.4% NBAL p=0.01) or were assaulted (6.7% HBAL, 4.8% LBAL, 2.14% LBAL, p<0.001). The median Injury Severity Score (ISS) was 10 in all 3 groups, p=0.68. There were no significant differences in major injury patterns (Abbreviated Injury Score>3) amongst the groups, except for a difference in major face injuries (0.1% NBAL vs 1.2% LBAL vs 1.6% HBAL). The groups had a similar frequency of comorbidities (70.0% NBAL, 69.9% LBAL, 73.1% LBAL, p=0.56). The overall (major and minor) complication rate was higher in the HBAL group (14.4% vs 7.2% LBAL, 0.3% NBAL, p<0.001). However, there was no significant difference in hospital length of stay (7 [4-14] hBAL, 7 [3-11] LBAL, 6[4-11] NBAL, p=0.67), major complications (8.0% HBAL, 6.0% LBAL, 7.5% NBAL, p=0.83), or mortality (2.2% HBAL, 2.4% LBAL, 3.3% NBAL, p=0.55) amongst groups. In multivariate analysis, an elevated BAL level was also not associated with mortality. Additional demographics and outcomes are presented in Table 1.
Conclusion: Principal findings of this study were: 22% of admitted patients were intoxicated; over 79% of those were highly intoxicated. The data suggest that alcohol intoxication is hazardous even when not driving: patients with elevated BALs were more often assaulted, sustained penetrating trauma, or were struck by motor vehicles, Elevated BAL patients had a higher overall complication rate and more frequently experienced alcohol/drug withdrawal. However, a negative admission BAL did not preclude the presence of alcoholism or the development of withdrawal.
